Trigger Point Injections Followed by Immediate Myofascial Release in the Treatment of Myofascial Pelvic Pain

Abstract

Purpose Pelvic floor physical therapy (PFPT) is first line therapy for treatment of myofascial pelvic pain (MFPP). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone. Methods This was a retrospective cohort analysis of 87 female patients with MFPP who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release. Results Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4 respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008). Conclusions PFTPI immediately followed by PFPT offered more improvement in pain for patients with MFPP. This may be due to greater tolerance of myofascial release immediately following injections.